APA, Washington, May 3-8: For the better part of six days, at their annual convention in Washington's sprawling Convention Center, psychiatrists shuffled from symposia to workshops to industry sponsored CME evenings, selecting sessions from a menu rich ranging from gene environments or brain substrates, to practical approaches to prescribing medication, preventing violence against women, or becoming a successful author. As robust as any image in my mind from the hundreds delivered (although I only attended several) are talks by two unique women, Patty Duke and Elyn Saks. I can think of no better way to describe the highlights of this meeting for me than to begin with their talks, through which part of my experience at this conference was filtered.

Patty Duke

Patty Duke is still working miracles. It was hard not to be immediately drawn to this award-winning actress with self-deprecating humor and an easy, throaty laugh, while she kept several hundred psychiatrists riveted for a 50-minute hour on Tuesday afternoon. Duke started speaking publicly about her illness more than two decades ago, a time when a powerful stigma silenced most people. She has not stopped. That she can connect as easily to families as to psychiatrists, shows her mission of spreading the word about successful treatments for people with bipolar disorder still has an audience.

Duke spoke on stage with Dr. Althea Stewart, who just stepped down from directing the American Psychiatric Foundation. Her life -- mania leading to acting out sprees, several unsuccessful marriages, and raising kids while pulling off an award-winning acting career before she was diagnosed at the age of 35 -- has been enriched by the telling of this story and its power to connect her to others. She combined artistry combined with altruism and appreciation, it was clear the respect went in both directions when Duke brought this audience to its feet.

Elyn R. Saks, JD
Last year Elyn Saks stunned readers with a remarkable book, The Center Cannot Hold: My Journey Through Madness. It is a memoir rich with insight, as she at times her book seems more poetry than prose. On Tuesday night, she appeared among the faculty of an industry-sponsored dinner symposium on schizophrenia. My purpose in writing this book, she said, was "to give hope to those who suffer from schizophrenia and understanding to those who don't." Of that there can be no doubt. Rarely does an author capture the chaos, terror, magic and self-awareness of psychosis from the inside with the eloquence and confidence she has.

Saks is a professor and dean at the Gould School of Law, University of Southern California. She graduated first in her class from Vanderbilt University, and was a Marshall Scholar Oxford University before attending Yale Law School. These accomplishments were not lost on psychiatrists, many of whom routinely underestimate the intellectual potential of people diagnosed with schizophrenia partly measured by cognitive deficits.

Saks credited two treatment interventions with helping her manage her illness. One is medication which she initially disdained until the proper drug, in the proper amount eventually became an ally. The other is psychoanalysis.

It seems ironic that Saks kicked off an evening of presentations about about medication -- the CATIE and CUtLASS trials, drug interactions, metabolic side effects, and compliance -- by discussing the importance of a therapy used infrequently now, even less so since a 15 minute med check has replaced much of the personal interaction in a treatment dynamic. And of all the talk therapies, psychoanalysis has gone out of vogue for treating psychotic illnesses. It will be interesting to see whether a growing emphasis on personal narrative and story line will recharge this instrument for healing and self-learning.

Like Duke, Elyn Saks' journey informed and inspired. For the second time that day I saw hundreds of psychiatrists stand in awe of two remarkable individuals.